AFFECT REGULATION: CONSCIOUSLY MANAGING FEELINGS

Human beings are endowed with the capacity to construct language and also be the beneficiary of its immensity in terms of construing meaning out of it as well as establishing an acceptable code of communication in which the society can cohere. In addition to the capacity to laugh, the ability to use language discerns us from animals and other species. Through language we can express our needs, emotions, deeper feelings, imaginations, ideas, humour, compassion, knowledge, and hordes of other aspects. The acquisition of language however takes 18 months. How does the infant survive in the interim period and in particular the first 6 months?

They are equipped with ‘affect’, an innate attribute structurally designed for infant’s survival, which if accurately picked up by the primary carer, allows the infant to attain homeostatic equilibrium (body’s ability to de-stress and maintain stability such as regulation of internal temperature, blood pressure, electrolyte levels etc.). As stated by Dr. Alan Schore, ‘Face to face interactions emerge at approximately 2 months of age, are highly arousing, affect laden, short interpersonal events that expose infants to high levels of cognitive and social information.’ He goes on to highlight this affect-laden communication as the life saving conduit in the infant-mother relationship prior to development of language.

Does it mean that once the child picks up language, the function of affect arousal is made redundant? Affects are present throughout life. There are multiple strands associated with affect that intrigues us such as:

What is affect?

Does it happen to us or do we choose it?

Can affect be consciously regulated?

Is cognition a pre-requisite to regulate affect?

Cognition from a psychological stand point denotes a combination of Perception, Memory, Learning, Thinking, Attention, Judgment, Evaluation, Reasoning, Recognition, Computation, Decision making and Language comprehension. When I say ‘Is cognition is a pre-requisite to regulate affect’, the cognition here means ‘one possessing the mental faculty to think and understand through thought.’ For example after a Tsunami one may have experienced loss of limb and trauma. One may also construe life thereafter as devoid of meaning and there are people who do become suicidal but there are also people who deliberately think differently and reconstitute the perception of their trauma as an ‘event- triggered unavoidable force majeure’, or in simpler terms, an accidental calamity, and look at ‘life and living’ more positively. By adopting the latter stance the person can be construed as using cognition to regulate affect. We will delve more into it when we arrive at the ‘cognitive appraisals’ section in this blog.

WHAT IS AFFECT?

Emotions, feelings and affects are interchangeably used in psychotherapeutic arena, as there seems to be no agreeable differentiation in literature. A logical explanation from Eric Shouse, appears as follows, ‘A feeling is a sensation that is checked against previous experiences and labelled.’ Therefore an infant doesn’t experience feelings, as he/she neither has a repertoire of past experiences nor developed language sophistication nor the capacity to cognitively process incoming environmental stimuli or inner body sensations. The infant expresses this inexplicable phenomenon happening inside through ‘affect’. Affect is the precise felt experience inside and as indicated by Shouse, it is manifested through facial muscles, the viscera, respiratory system and vocalisations. Fonagy (2002) emphasizes action centricity when he states, ‘Affects are designed to lead us to action. Affects prepare the body for action either initiate the action as in adults or make an infant receive action. For example an infant experiencing such affects either demonstrates contortions on the face (eyes closed in a sort of torment) or lets out a piercing shriek which, a fully attuned mother picks up and administers the necessary care.

Emotions, on the other hand, has some kind of an elicitation strategy attached to it. Amorous, angry, afraid etc. are emotions which Bowlby (1969) calls denoting emotions. It is a learnt with conditioning. I may feel bitterness (affect) inside me but I could project either a calm exterior or an emotion of anger. All of us unequivocally do it; we conduct ourselves at work and social engagements with civility and suppress many feelings and project other emotions.

Feelings express our true sensations while emotions reveal how we have been taught to respond to various life events, a kind of maintaining an expressive self. Emotions are expressive in nature but affects could also be enduring moods without any specific evoking conditions for example a general feeling of anxiety, depression, hopeless, cheerful, confident, calm, elation etc. Immediate triggering vectors may not always be present but a sort of indolence and lack of motivation could be experienced in case of anxiety. It is when negative affects get out of kilter that patients come to therapy.

In this blog, we are not getting embroiled in the refined distinctions between emotions and affects but the difference is presented here to reinforce our understanding of what exactly is affect.

WHAT IS AFFECT REGULATION?

Affect regulation is an individual’s capacity to regulate their emotional state and inner feelings in order to adapt to the external environmental as well as to adapt to the internal organismic stimuli. The external environmental stimuli are visual, sound, taste, touch and smell each of which can cause a state change in us. The internal organismic stimuli are the thoughts generated in one’s head that also affects one’s inner feelings. Affect regulation is the key in alleviating the negative state and as stated by Bradley (2009), ‘All effective psychotherapies appear to provide their recipients with improved capacity to regulate affect.’ Fonagy suggests, ‘Affect regulation plays a crucial part in the explanation of how infants move from a state of co-regulation to self-regulation. Co-regulation uses the physical and psychological resources of the mother or carer.

CONSCIOUSNESS AND AFFECT REGULATION

Here is an interesting view. Fonagy has stated that ‘Affect regulation is equivalent to homeostasis: it occurs approximately and largely outside conscious awareness. I concur with first part that homeostasis, the body’s internal regulating mechanism to keep it stable, does happen outside our conscious awareness and perhaps with a degree of automaticity to it, however I believe that cognition has a strong role in making us interpret the external stimuli which fires up our sympathetic and parasympathetic nervous systems. This has such a weighty linkage to homeostatic preservation.

Johnson (1994) expresses the following view, ‘such stimuli may not necessarily be consciously experienced as threatening and the individual may be totally unaware of the nature of the triggering stimuli. But at an unconscious level at least, the stimuli releases the terror response.’ Yes, it is unquestionably possible for stimuli to altogether elude consciousness due to the way we are conditioned, after all we remain inattentive to so many aspects in our life however it is my estimate that our interpretation of this environmental/organismic stimuli can also be brought into consciousness and that it can be influenced and controlled with cognition.

From this standpoint, I do not believe affect regulation happen outside our conscious awareness always. I however agree with Antonio Damasio’s thought in his book ‘Decartes Error’ that, ‘Some of the basic regulatory mechanisms operate at covert level and are never knowable to the individual.’ Freud asserted that by definition, affects are conscious phenomena and hence we cannot properly speak of unconscious anxiety, unconscious guilt or unconscious grief.’

COGNITIVE APPRAISALS AND AFECT REGULATION

Arieti (1970) has stated, ‘Cognitive appraisals can change a simple reflex action if the motivation to do so is enough.’ I draw attention to cognitive appraisals in the above line. The anthropologist Shweder makes an important distinction for me here. He regards basic emotions as ‘a construct of language that relies on appraisals of value rather than on anything that is found in nature.’ (Fonagy et al., 2002). Let me present an example from Cantor and Glucksman (1983) to explain this.

A man dining alone at a restaurant picks up a hot plate and shouts at the waiter for not mentioning to him that it was ‘hot out of the oven’. The following night he is dining with a woman. The same waiter brings the hot plate and inadvertently the man touches it again but this time endures the pain and saves his invectives for another day. In the first instance the man’s affect (displeasure & irritation) was invoked due to his perception of the waiter having transgressed the value, which was ‘safety’. In the second instance he could regulate his affect with cognition and own volition when he replaced the ‘safety’ value with ‘etiquette & poise’ value, perhaps to impress the woman. Cognitive re-appraisal has happened here. As stated by Bowlby, ‘Feeling hot, feeling cold, feeling hungry are not raw sensations but phases of certain sensory inputs in the course of being appraised.’

As conceptualized by Gross (1999), ‘Cognitive reappraisal is an antecedent-focused strategy that involves the cognitive reconstrual of the emotion-eliciting event in a way that changes its emotional impact.’ For example we can say ‘he is a horrible person’ and this may alter our state to being agitated or angry. Instead a cognitive reappraisal can be achieved here, say for instance as Abraham Lincoln put it, ‘I don’t like that man, I must get to know him better.’ The latter stance changes one’s emotional state from anger to one of ‘acceptance and possibility’. Stephen Hawking and Nick Vujicic are case in point, both of who made cognitive reappraisals of their situation and attached larger meaning to life and contribution. Here is the touching video from Nick Vujicic:

I attribute considerable therapeutic signification to Bowlby’s statement, ‘since appraising process may or may not be felt, it is the appraising process rather than the feeling and emotion that require first attention.’

As we grow and develop, we acquire the capacity to consciously attach any value or meaning to experience which consequently either exacerbates or regulates our affects. Bradley in stating Lazarus and Folkman, highlights that, ‘It is the individual’s cognitive appraisal of a situation that contributes to his/her judgment of stressfulness.’ Bradley states that both positive and negative affect may be elaborated into emotional feelings through experience and cognition. Cognition therefore has tremendous significance in affect regulation. Lazarus (1984), seem to supplement this view when he states, ‘There is no such thing as affective experience without cognition’ (Fonagy et al., 2002). This is a very intrepid and emphatic statement. Cognition does prodigiously contribute towards both experiencing affect and its regulation however I would add that in certain instances, even cognition is not enough to prevent negative affects and the next paragraph exemplifies this stance.

Fonagy has stated that ‘Regulation prompts us to alter our state and to act expeditiously in circumstances where this is necessary – such as extreme situations in which survival is at stake.’ When it is a question of extreme threat as in mortal danger needing a fight or flight response, the orbitofrontal cortices shuts down and body prepares for action. Cognition seem to be suspended. Here is an example (as narrated by Robert Winston in his book ‘The Human Mind’). “During the filming of ‘The Human Mind’ I stood wearing breathing apparatus in a flimsy iron cage in the sea off Cape Town while a two-ton, 18 foot long great white shark bore down on me, rattling my cage and showing its rows of four-inch teeth. No matter how much my cerebral cortex was telling me ‘I could keep calm and that I was not going to get hurt’, the alarm bells in my amygdala were ringing unbearably.” In spite of knowing that the cage is made of sophisticated metallurgy that resists a bull shark’s bite strength (a force of 6000 Newtons), Winston couldn’t remain calm.

Cognition did not help regulate his affect here due to presence of lurking danger. Whilst he awaits the questing and encircling shark to vanish, what are the chances that the ripped and mangled steel cage from the movie ‘Jaws’, flashed before his eye at least once! This evidence anyway is subservient to our main construct and the point is, yes cognition cannot regulate negative affect at all times but whenever affect is regulated, cognition has played a part. A newborn infant may lack these cognitive abilities but with maturation of attention systems they learn to regulate affects.

ADOPTION STANCE IN THE THERAPY ROOM

If one were to take the intactness of Fonagy’s statement that ‘affect regulation does indeed happen outside our conscious awareness’, then it would make people abnegate action and responsibility to improve their feeling states thereby succumbing to anxiety, distress and despair. There are many who adopt such a demeanour and use dissociation, acting out, regression and other inchoate strategies. What I mean by this is that unless we know that affects can be modulated and regulated consciously, there is no impetus to change and psychotherapy would never have developed. Through therapy, be it any modality, psychodynamic, humanistic, existential, CBT etc., the client understands and reflectively re-assimilates their own experience. A reformulation of perception induces a change in feeling and affective states. As Bowlby puts it, ‘only after a patient has become emotionally aware of how and what he is feeling can therapeutic change be expected.’

DO AFFECTS HAPPEN TO US OR DO WE CHOOSE IT?

There is agreement on the construct that affects are innate and that all human beings experience it. At the very start of life everything causes fright or alarm to the infant and since there is nothing to choose from, affect seems to be happening to them. With passage of time as the infant’s sensorimotor control strengthens with development, acclimatization and attunement with the carer, the infant learns to modulate and regulate affect. Here is an example: An infant hears a loud sound in first month, is terrified and his negative affects are invoked. He looks at his carer’s expression and if the carer soothes him and through facial gestures communicates that the sound is okay, he picks up the carer’s state. In this instance the sound is consigned to the infant’s memory as a fairly harmless one. Contrary to this, if the carer is aghast at the sound and expresses anxious and terror-stricken expressions, the infant also becomes anxious and his negative affect is raised. This sequence will now be indelibly etched in the infant’s memory. Memory and cognition therefore play a significant part in the infant’s interpretation. How the infant perceives his world right from inceptive to various developmental stages depend upon his coping mechanism.

CONCLUSION

We possess the attributes to choose our affects, which could engender a change in our state, and that affects are not some phenomenon ‘happening to us’. In short we choose how we feel in a given situation. As stated by Fonagy, ‘If we manage to withhold our consent to the overpowering force of affects, we can achieve the ‘detachment’ and ‘self-sufficiency’ by virtue of which we are able to flourish.’ Affect happens as per our own volition but clients are unaware about this. As derived by Bowlby, a patient who has no insight into his feelings cannot report that he feels angry with his wife or is still grieving for his mother. ‘Language of feeling is valuable in clinical work.’(Bowlby, 1969).

Regulating affects in a positive and restorative way is important as against using dissociation, repression, somatization and other enfeebled ways. Not all clients are psychologically minded to bring themselves to such a metacognitive stage and this perhaps is one of the biggest challenges in therapy. Relatedness, resonance with client’s view, empathically entering client’s internal world of reference, phenomenological inquiry into client’s experience, unconditional positive regard, understanding client’s recurring themes and patterns, challenging clients critical assumptions, etc. are a few amongst the prevalent tools in the armamentarium of the therapist that he/she must sharpen the acuity of.

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